Video consultations in medication overuse headache. A randomized controlled trial

Abstract

Objective: To test the hypothesis that the effect of video consultations is noninferior to traditional consultations in managing patients with overuse headache (MOH).

Materials and methods: Patients were recruited from referrals to a neurological clinic. In a randomized controlled trial (RCT), headache burden measured by headache impact test (HIT-6) and frequency of headache days <15 per month and visual analogue pain scale (VAS) at baseline, 3 months and 1 year were compared between groups consulted by video- (n = 51) and traditional consultations (n = 51) in a post hoc analysis.

Results: The overall response rate was 74.5%. HIT-6 changed from 66.3 (SD = 4.7) to 60.0 (SD = 9.1) from baseline to 12 months in participants randomized to video consultations and from 65.8 (SD = 3.7) to 58.4 (SD = 8.3) in the group consulted traditionally (95% CI -2.3 to 6.5, p = 0.44). Frequency of headache days <15 per month at 1-year follow-up were 9 (23.1%) respectively 10 (27.0%), p = 0.60. In the video group, VAS improved by 2.3 points compared to 2.4 in the traditional group from baseline to 12 months (95% CI -1.2 to 1.2, p = 0.76). Analyses of repeated measurements comparing HIT-6 and VAS over two points of time in the two groups were insignificant.

Conclusion: The effect of video consultations is noninferior to traditional consultations in managing MOH patients. Using video may be a good alternative in consulting patients with MOH.

Keywords: MOH; RCT; headache; health service; management; medication overuse headache; telemedicine.

Figure 1

Flowdiagram of participants throughout the study

Figure 2

Comparisons of HIT‐6 over three time points between headache patients randomized to video consultations and traditional consultations. There were no differences between the groups (mixed design ANOVA; F(2, 62) = 0.381, p = 0.54)

Figure 3

Comparisons of visual analogue scale (VAS) over three time points between headache patients randomized to video consultations and traditional consultations. There were no differences between the groups (mixed design ANOVA; F(1, 56) = 0.117, p = 0.73)